Today, mental health and substance use conditions drive nearly 57% of all health care spending when combining their physical comorbidities. These patients are 10 times more likely to be forced out-of-network for care than individuals without mental illness or substance use disorders.

Addressing the systemic challenges in realizing parity requires pinpointing exactly where disparity exists and highlighting specific opportunities for improving coverage and access. Previously, measuring parity in specific markets at the insurance plan level in real-time was impossible due to the proprietary nature of insurance carrier networks and prior limitations of available data.

This project provides a transformative new opportunity to measure parity by illuminating new data published through the Health Plan Transparency rules, which includes all negotiated contract in-network arrangements, including pricing between every health insurer and provider nationwide.

Overview

The bipartisan Mental Health Parity and Addiction Equity Act (MHPAEA), co-authored by Congressman Patrick J. Kennedy and signed into law by President George W. Bush in 2008, laid the foundation for protecting individuals with a mental illness or substance use disorder to ensure they receive the same level of health insurance access and coverage for care as individuals with any other physical health condition receive.

However, nearly twenty years later, the 156 million Americans with commercial insurance remain 1,000 times more likely to be forced out-of-network for mental health and substance use services compared to physical health benefits. Beneficiaries often pay more out of pocket for mental health and substance use services than other physical health services, which are more frequently covered in-network. Lack of coverage and access has resulted in increased suffering, higher health care costs, and has been a key factor in driving the overwhelming overdose and suicide rates nationwide.

To evaluate parity, The Kennedy Forum, along with founding strategic partners Third Horizon and the American Medical Association, developed a new open-access online tool, the Mental Health Parity Index, for piloting in the State of Illinois. This revolutionary new tool analyzes commercial insurance plans based on coverage and access to mental health and substance use services compared to physical health services using Transparency in Coverage data published in machine-readable files by individual insurance carriers. The project team is using the in-network payer files published by the insurance carriers themselves to provide an analysis of these key components of access to coverage:

• Network Composition: The percent of in-network MH/SUD providers out of all available MH/SUD providers in the area, compared to physical health.
• Outpatient Professional Reimbursement: In-network reimbursement rates for outpatient MH/SUD services compared to physical health, normalized against the amount of cost and effort for each service and weighted based on how often the service is performed.
• Inpatient Acute Reimbursement: In-network reimbursement rates for inpatient acute MH/SUD services compared to physical health, normalized against the amount of cost and effort for each service – both at the total rate and per day (per diem).

Please Note:

The Mental Health Parity Index is a research-focused analysis that highlights areas of potential concern and opportunity for improving access and coverage to mental health and substance use services. The insights derived from the work are provided for informational purposes only and do not themselves indicate any legal compliance issue, including any direct indication of a violation of the MHPAEA law, but a likely area for regulatory inquiry. The machine-readable files used for this research are third-party public data sets not published or produced by a research body or government entity. The underlying data used in this application are published by individual private companies, and in no way can The Kennedy Forum or its partners independently validate the completeness or accuracy of each insurance plan’s machine-readable file. The entities obligated to comply with the existing Transparency in Coverage rules issued by The Centers for Medicare and Medicaid Services, including commercial health insurance plans, are responsible for the publication of the data. The primary limitation of this data is it only provides insight as to whether a provider is contracted in-network and the contracted price; it does not indicate if a provider is accepting new patients nor how frequently individual plan beneficiaries utilize the published contracted service. However, the project team has created weighted views of the outputs by utilizing a representative claims data set to provide a signal for the most frequently used services in the market. For more details and other limitations encountered, please access the detailed methodology file found within the full application.

*The development of the initial Illinois Pilot was made possible in part by the Illinois General Assembly

Project Advisors and Reviewers

The methodology and analytic approach to this work were developed with technical assistance and input from subject matter experts and organizations listed below:

Organizations

• American Foundation for Suicide Prevention
• American Hospital Association
• American Medical Association
• Legal Action Center
• Mental Health America
• National Association for Behavioral Healthcare
• National Council for Mental Wellbeing

Individuals

• Rochelle Archuleta, National Association for Behavioral Healthcare
• Meiram Bendat, Psych-Appeal
• Francois de Brantes, XO Health
• Susan Busch, Yale School of Public Health
• Alisa B. Busch, McLean Hospital, Harvard Medical School
• Tim Clement, Mental Health America
• Richard G. Frank, The Brookings Institution
• Ishani Ganguli, Harvard Medical School, Brigham and Women’s Hospital
• Caitlin Gillooley, American Hospital Association
• David Lloyd, Inseparable
• Alan Nessman, American Psychological Association
• John O’Brien, Independent Consultant
• Lawrence Van Horn, Preverity Inc.
• Laurel Stine, American Foundation for Suicide Prevention
• Deborah Steinberg, Legal Action Center
• Erin F. Swedish, American Psychological Association
• Reyna Taylor, National Council for Mental Wellbeing
• Becky Yowell, American Psychiatric Association

Disclaimer

The Mental Health Parity Index (“MHPI”) is for informational purposes only. The content is believed to be current as of February 2025. Mention of a third-party organization, product, or service in the MHPI does not imply and is not intended as a promotion or endorsement by The Kennedy Forum, AMA, or Third Horizon Strategies (“Developers”), or any of the organizations or individuals who reviewed the content. This content is not intended as medical, legal, or consulting advice, or as a substitute for the advice of a physician, attorney, or other professional. The content does not make nor should it be used to draw any medical or legal conclusions. The positions and conclusions expressed or implied in the MHPI do not necessarily reflect the positions or conclusions of Developers. Because all the data in the MHPI originates with third parties, the Developers make no warranty regarding the accuracy or completeness of any information provided in or by the MHPI. The MHPI is provided as-is.